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Kobe Bryant Tear Achilles and Undergoes Surgery PDF Print E-mail

Friday night, Kobe Bryant of the Lakers suffered a left Achilles tear. On Saturday he underwent surgery to repair the tendon. Now everyone is asking if and when he will be back.

ANATOMY

The Achilles tendon is the longest tendon in the human body. It is made up of two muscles: the gastrocnemius muscle and the soleus muscle. The muscular unit of the tendon attaches from the back of the knee to the heel bone. About 2/3 of the way down the leg, the muscle bellys transition to the Achilles tendon. The Achilles tendon is prone to injury in the area known as the watershed area. This area goes from 2-6 centimeters up from the attachment site of the Achilles tendon to the heel bone. In the watershed area, the blood supply to the tendon is poor. This is an area where the tendon has a poor ability to heal itself. Most Achilles tendon tears occur in this area.

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The Achilles tendon functions to bring the ankle downward, similar to the motion of press on the gas pedal. With jumping activities, the Achilles tendon sees forces 8 times that of one's body weight. With sprinting activities, that force increases to 12 times that of one's body weight.

CAUSES

Achilles tendon tears or ruptures are commonly seen in weekend warriors and those who participate in sports with a lot of push-off actions. Some patients who have been on an antibiotic from the fluoroquinolone family may be at risk of tearing the Achilles tendon.

SYMPTOMS

Patients will report a sudden pop in the back of the ankle and a rush of blood. Some will say they feel like someone has kicked them in the back of the ankle. They will notice a loss of strength in the foot when trying to stand on the ball of the feet. Pain, swelling, and bruising are common. When carefully touching the Achilles tendon in the watershed area, a gap may be felt in the tendon. Achilles tendon tears can not be seen on xray. Very rarely is an MRI or ultrasound needed to make the diagnosis. The diagnosis is usually made with physical exam findings alone. WHEN TO SEEK MEDICAL CARE If you are concerned about an Achilles tendon tear, you should see a medical professional within hours or days of the injury.

TREATMENT

Treatment options range from non-surgical options to surgical options using a variety of techniques. Non-surgical options are reserved for those patients who are against surgery, are elderly, are medically too sick to withstand surgery, or are not active. The treatment involves a short leg, non-weightbearing cast for 8 to 10 weeks, followed by extensive physical therapy. Surgical options are recommended in the athletes and active population. There are three techniques that are used:

1. The traditional open technique where an 8 to 10 centimeter incision is made on the back of the ankle. The tear is cleaned out and the tendon ends are sutured together. The number one complication of this approach is wound healing issues. You can see a video of this technique at:

2. A percutaneous technique where needles are placed through the skin and Achilles tendon. The tendon ends are never seen, so it is difficult to be sure that they are toughing when the tendon ends are sutured together.

3. A mini-open technique using a 2 to 3 centimeter incision on the back of the Achilles. In this technique, the tendon ends are seen and cleaned. A small device is used to place the sutures in the tendon. The tendon ends are then brought together. You can see a video of this technique at:

OUTCOMES

Nonsurgical patients have an 18-20% chance of re-tearing the Achilles and lose some push-off power. This is a concern for elite athletes. Surgically treated patients have approximately a 2% chance of re-tearing the tendon and have a more normal push off in the injured ankle.

RETURN TO ACTIVITIES

Earlier this year, a study showed that NBA players who returned to play after repair of complete Achilles tendon rupture showed a significant decrease in playing time and performance. A total of 38.9% of players never returned to play.

We conducted a study on NFL players who had an Achilles tendon tear. In general, only about 66% of players were able to return to the NFL and took about 11 months to do so. Furthermore, when they returned to the NFL, their performance was severely affected. To read this paper, see: http://www.lowerextremityreview.com/index.php/article/return-to-football-after-achilles-tendon-rupture

Based on these studies, Kobe has a nearly 40% chance to never return to the NBA. Furthermore, if he returns, the shortest time frame I would expect him to play is 7-9 months. During his first season of play back, he is likely to have fewer minutes played per game. However, having said this, athletes have returned to play in remarkable fashion.

VIDEO/ANIMATIONS

 

To watch a live surgical video of an open Achilles repair, go to:

To watch a live surgical video of a mini open repair, go to:

Dr. P

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All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog. For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/ For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

 
Terrell Suggs of Baltimore Ravens Tears Achilles PDF Print E-mail

 

 

 

 

Terrell Suggs of the Baltimore Ravens reportedly ruptured his Achilles tenon on Saturday.  Will he return this season?

Anatomy

The Achilles tendon is the longest tendon in the human body.  It is made up of two muscles: the gastrocnemius muscle and the soleus muscle.  The muscular unit of the tendon attaches from the back of the knee to the heel bone.  About 2/3 of the way down the leg, the muscle bellys transition to the Achilles tendon.  The Achilles tendon is prone to injury in the area known as the watershed area.  This area goes from 2-6 centimeters up from the attachment site of the Achilles tendon to the heel bone. In the watershed area, the blood supply to the tendon is poor.  This is an area where the tendon has a poor ability to heal itself.  Most Achilles tendon tears occur in this area. 

 

The Achilles tendon functions to bring the ankle downward, similar to the motion of press on the gas pedal.  With jumping activities, the Achilles tendon sees forces 8 times that of one's body weight.  With sprinting activities, that force increases to 12 times that of one's body weight.

 

CAUSES

Achilles tendon tears or ruptures are commonly seen in weekend warriors and those who participate in sports with a lot of push-off actions.  Some patients who have been on an antibiotic from the fluoroquinolone family may be at risk of tearing the Achilles tendon.

SYMPTOMS

Patients will report a sudden pop in the back of the ankle and a rush of blood. Some will say they feel like someone has kicked them in the back of the ankle.  They will notice a loss of strength in the foot when trying to stand on the ball of the feet.  Pain, swelling, and bruising are common.  When carefully touching the Achilles tendon in the watershed area, a gap may be felt in the tendon. Achilles tendon tears can not be seen on xray.  Very rarely is an MRI or ultrasound needed to make the diagnosis.  The diagnosis is usually made with physical exam findings alone.

WHEN TO SEEK MEDICAL CARE

If you are concerned about an Achilles tendon tear, you should see a medical professional within hours or days of the injury.

TREATMENT

Treatment options range from non-surgical options to surgical options using a variety of techniques.

Non-surgical options are reserved for those patients who are against surgery, are elderly, are medically too sick to withstand surgery, or are not active. The treatment involves a short leg, non-weightbearing cast for 8 to 10 weeks, followed by extensive physical therapy.

Surgical options are recommended in the athletes and active population.  There are three techniques that are used:

1. The traditional open technique where an 8 to 10 centimeter incision is made on the back of the ankle.  The tear is cleaned out and the tendon ends are sutured together.  The number one complication of this approach is  wound healing issues. You can see a video of this technique at: http://www.youtube.com/watch?v=uzzV5BRWlIc

2. A percutaneous technique where needles are placed through the skin and Achilles tendon.  The tendon ends are never seen, so it is difficult to be sure that they are toughing when the tendon ends are sutured together.

3. A mini-open technique using a 2 to 3 centimeter incision on the back of the Achilles. In this technique, the tendon ends are seen and cleaned.  A small device is used to place the sutures in the tendon.  The tendon ends are then brought together. You can see a video of this technique at: http://www.youtube.com/watch?v=QgSeD8lyQaM

OUTCOMES

Nonsurgical patients have an 18-20% chance of re-tearing the Achilles and lose some push-off power.  This is a concern for elite athletes.  Surgically treated patients have approximately a 2% chance of re-tearing the tendon and have a more normal push off in the injured ankle.  

RETURN TO ACTIVITIES

We conducted a study on NFL players who had an Achilles tendon tear.  In general, only about 66% of players were able to return to the NFL and took about 11 months to do so.  Furthermore, when they returned to the NFL, their performance was severely affected. To read this paper, see:  http://www.lowerextremityreview.com/index.php/article/return-to-football-after-achilles-tendon-rupture

It is unlikely for Suggs to make it back this coming season. 

VIDEO/ANIMATIONS

To watch a live surgical video of an open Achilles repair, go to:

http://www.youtube.com/watch?v=24jAAZ2s-04&feature=plcp

To watch a live surgical video of a mini open repair, go to:

http://www.youtube.com/watch?v=rD3aI_7EneA&feature=plcp

 

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Dr. P

-----------------------------------------------------------------------------------------------------------

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

 

 

 

 

 
Derrick Rose, Guard of the Chicago Bulls, Out for Season and Olympics PDF Print E-mail

 

Guard, Derrick Rose of the Chicago Bulls injured his right knee.  He was diagnosed with an ACL tear.  

Will he be able to return next year?

ANATOMY

The knee is a complex joint, with four main ligaments that stabilize the joint: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the lateral collateral ligament (LCL) tear, and the medial collateral ligament (MCL).  Together, these four ligaments help to stabilize the knee in all planes of motion. 

The ACL stabilizes the knee and prevents it from "giving out," particularly when twisting or bending on the knee.  

CAUSES

An ACL tear is usually seen in the athlete during sporting activities, but it can happen with other mechanisms, such as motor vehicle accidents and falls. Usually these injuries are "non-contact" injuries, occurring when the athlete lands on the knee after jumping.  The pivoting or twisting of the knee stresses the ACL and causes it to tear.  

Female athletes are at a higher risk of developing an ACL tear.  It is not enirely clear why this is the case.  However there are thoughts that the anatomical differences in a woman, hormones, or even biomachanical differences in a female versus a male may account for this higher risk.  

WHEN TO SEEK MEDICAL CARE

If you believe you have an ACL tear, you should seek medical attention immediately.

SIGNS

When one tears the ACL, there is usually a pop that is heard with sudden pain in the knee. There may be swelling of the knee (effusion), black and blue discoloration, knee stiffness, or the feeling of instability.  The individual may have difficulty walking on the knee.  An MRI can diagnose the ACL tear and any other injuries of the knee.

TREATMENT 

Not all individuals with ACL tears require surgery.  If there are symptoms of instability of the knee or if one is a high level athlete, then the surgery would be preferred.  If you do not fall into any of these categories, then a knee brace, followed by extensive physical therapy can be used to treat these injuries.

Surgical reconstruction of the ACL can be performed in a variety of different ways.  The ACL can be reconstructed with the patients own tisssues (autograft) or tissues from a person who has died (allograft).  Autograft reconsturction may require harvesting the "new" tendon from either the patellar tendon or the semitendinosus tendon (one of the hamstring tendons).  Different techniques can also be used to reconstruct the tendon, such as single bundle or double bundle techniques.  These discussions are beyond the scope of this blog.

Rehabilitation is critical to the success of surgical or non-surgical treatments for ACL tears.  

OUTCOMES

In 2005, we presented data on NFL athletes with ACL injuries.  Of the 31 running backs and wide receivers with 33 anterior cruciate ligament injuries, more than one fifth of players never returned to a National Football League game. Returning players first competed in a game 55.8 ± 5.4 weeks (mean ± standard error) after injury. For the 24 anterior cruciate ligament–injured players with a minimum total power rating (sum of all 7 seasons) of 200 points, power rating per game played decreased from 9.9 ± 1.1 preinjury to 6.5 ± 0.9 postinjury. This decline in power rating per game played was statistically significant (P = .002) when compared with the change for the 146 control players.  http://ajs.sagepub.com/content/34/12/1911.abstract

RETURN TO ACTIVITIES

If we use the above study as a guideline for the return to professional sports, it is likely that Rose will be back on the court somewhere between six and nine months.  He will need a lot of work and rehabilitation in order to return to his pre-injury level.

VIDEO/ANIMATIONS 

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Good luck Rose.

Dr. P

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All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

 

 
Orlando Magic Center Dwight Howard's Season Is Over PDF Print E-mail

 

The Orlando Magic received devastating news today: center Dwight Howard will be undergoing back surgery for a herniated disc.  When will he be back?

ANATOMY

The spine is made up of vertebral bodies that make the vertebral column.  In the neck (cervical) region, there are 7 bones, in the back (thorax) region, there are 12 bones, and in the lower back (lumbar) region there are 5 bones.  


Each bone interacts in a complex manner with the bone above and beneath it. Furthermore, the spinal canal is home to the spinal cord.  Throughout the length of the spinal cord, nerves (known as nerve roots) come off the cord to provide function to that level of the body. 


In addition, between the bones are cushioned disks, known as vertebral discs, which act as shock absorbers along the length of the vertebral column. The intervertebral disc acts as a shock absorber for the spine.  It is made of two parts: a soft inner core and a tougher fibrous outer wall.  Finally a series of ligaments and muscles attach to the bones to provide stability and flexibility to the spine.

CAUSES

Herniated discs can occur for a number of reasons.  Most disc herniations occurring in the lower back occur with the normal aging process.  People who perform a lot of bending and twisting activities are at particular risk.  However, traumatic herniations are also possible. 

In a disc herniation, small tears develop in the tough outer wall of the disc.  Damaged pieces of the soft inner core bulge through the tear and out of the disc wall.  This part of the disc bulges into the spinal canal.  It can then push on the nerves.



SYMPTOMS

In the lower back, depending on the location of the herniation, the pressure on the nerve can cause pain, numbness, tingling, and loss of strength into one or both legs and feet, or even the buttocks region.  Some time bowel and bladder incontinence can develop, in a condition called cauda equina syndrome.

WHEN TO SEEK MEDICAL CARE

If you have pain shooting in to the legs or feet with associated weakness that does not improve, you should seek the care of a health care provider.  If you develop symptoms of cauda equina syndrome, you should seek help emergently.

A thorough physical exam, xrays, and often an MRI is needed to evaluate the spine.



TREATMENT

Most disc herniations are minor and can often be treated without surgery.  Anti-inflammatories, steroids, physical therapy, back supports, and epidurals can help relieve symptoms.

Surgery is considered for larger herniations, for patients whose pain does not improve or worsens.  In surgery, the herniated part of the disc is removed to decompress the nerve (discectomy).  If this is done through a small incision, it is known as a microdiscectomy.  Sometimes, a part of the vertebral bone, known as the lamina, may need to be removed as well. 

OUTCOMES

Most individuals are able to return to activities with associated pain relief.  This can take up to two years to occur.  Furthermore, at times, the disc can herniate again.

RETURN TO ACTIVITIES

With a microdiscectomy, Howard can take up to 4 to 6 months to return to sporting activities.  

VIDEO/ANIMATIONS 

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Dr. P

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All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

 

 
New York Knicks, Jeremy Lin, to Undergo Knee Surgery PDF Print E-mail

 

Linsanity will be pausing briefly.  Jeremy Lin, point guard for the New York Knicks, was diagnosed with a meniscal tear in his left knee.  He will undergo surgery later this week.  What is being done?

ANATOMY

The knee consists of 3 bones: the knee cap (patella), the thigh bone (femur), and the leg bone (tibia).  These three bones interact to give range of motion to the knee.  Inside the knee joint, the bones are covered with a substance known as cartilage.  The cartilage allows the bones to glide together, painlessly.  This substance is critical to the function of any joint in the human body.  Between the bones are cartilage discs, known as menisci.  These discs cushion the knee.

 

 

 

The meniscus can tear anywhere along its course.  These tears come in a variety of forms and can lead to pain, catching, popping, or clicking of the knee.

 

 

CAUSES

Meniscal tears can occur with trauma, twisting injuries, and arthritis.  Tears that are towards the central portion of the knee can be cleaned up, whereas those that are towards the periphery may be repaired.

SYMPTOMS

Not all meniscal tears cause symptoms.  However, symptoms can include pain, swelling, clicking, popping, or even catching.

TREATMENTS

Meniscal tears are treated with shaving procedure to “clean-up” the tear.  

 

Occasionally, if the tear is located towards the periphery of the meniscus, a repair can be attempted.

 

 

WHEN TO SEEK MEDICAL CARE

If you suspect that you have symptoms concerning for a cartilage injury of the meniscus, you should seek medical attention.  A good physical exam, x-rays, and an MRI may be needed to evaluate the injury.

RETURN TO ACTIVITIES/OUTCOMES

Most athletes with meniscal tears that are treated with a shaving procedure are out of competitive play for 3-4 weeks. Those with meniscal tears that need to be repaired are out from competitive plays for at least 3 to 4 months. Extensive rehabilitation is needed to optimize the range of motion and strength of the knee.

VIDEO/ANIMATION

For a video animation of "Anatomy of the Knee", please see the “Education” tab of my website.  Click orthopaedics, then knee, then conditions, then "Anatomy of the Knee".

For a video animation of "Meniscus Tears", please see the “Education” tab of my website.  Click orthopaedics, then knee, then conditions, then "Meniscus Tears".

For a video animation of "Partial Meniscectomy", please see the “Education” tab of my website.  Click orthopaedics, then knee, then procedures, then “Partial Meniscectomy".

For a video animation of "Meniscal Repair", please see the “Education” tab of my website.  Click orthopaedics, then knee, then procedures, then “Meniscal Repair ".

Lin will be out for 4-6 weeks. If the Knicks make it to the payoffs, he may be ready for play in mid to late May.

Dr. P

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All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

 

 

 
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